Coronavirus Disease 2019 (COVID-19) and the Incidence of Obstetric and Gynecologic Emergency Department Visits in an Integrated Health Care System.

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has had unprecedented effects on medical care worldwide. Studies have shown a reduction in the number of patients presenting to the hospital for emergent conditions such as acute myocardial infarction, and emergency department (ED) volume has declined in some hospitals by as much as 50%.[1-3] Currently, there is limited research on the effects of COVID-19 on the incidence of surgical emergencies, particularly in obstetric and gynecologic care.[4,5] Moreover, it is unclear how health care system usage has changed after the peak of COVID-19 infections and during subsequent re-opening efforts. We examined the incidence of obstetric and gynecologic emergencies using data from Kaiser Permanente Northern California, an integrated health care system that serves more than 1 million reproductive-aged women annually.

METHODS

We examined demographic and clinical characteristics and incidence rates (per 100,000 person-weeks at risk) of female patients aged 18 years or older presenting to a Kaiser Permanente Northern California ED with obstetric or gynecologic concerns before and during the COVID-19 pandemic. Obstetric and gynecologic conditions included vaginal bleeding, pelvic or vulvovaginal infection, pelvic pain, and other (Table 1). Incidence rates for the COVID-19 pandemic period (both early pandemic [March 4–May 19, 2020] and late pandemic [May 20–September 1, 2020]) were compared with those in the prepandemic period (January 1–March 3, 2020). March 4, 2020 was the date of the first reported death from COVID-19 in Northern California, and May 20, 2020 was the date that Kaiser Permanente Northern California resumed elective surgery cases. Additionally, to ensure that temporal differences were not due to seasonal fluctuations, we compared the prepandemic, early-pandemic, and late-pandemic periods in 2020 with the corresponding periods in 2019. Differences among time periods were compared with incidence rate ratios overall and stratified by key patient characteristics and diagnoses.[2] Our study was approved by the Kaiser Permanente Northern California Research Determination Office.

Table 1.

Obstetric and Gynecologic Emergency Department Visits During the Early and Late Pandemic Periods Compared With the Prepandemic Period in 2020

RESULTS

Data for 63,679,440 person-weeks from January 1 to September 1, 2020, were evaluated (Fig. 1). A total of 6,885 encounters occurred in an ED between January 1 and March 3, 2020 (incidence rate 42.2, 95% CI 41.2–43.2), compared with 4,903 encounters in the early pandemic period of March 4–May 20, 2020 (incidence rate 24.5, 95% CI 23.8–25.2), reflecting a 42% decrease in ED visit rates (incidence rate ratio 0.58, 95% CI 0.56–0.60) (Table 1). There was a significant but less pronounced decrease during the late pandemic period of May 20–September 1, 2020 (incidence rate ratio 0.82, 95% CI 0.79–0.84). Similar decreases were seen when early-pandemic obstetric and gynecologic ED presentations were analyzed separately (obstetric: incidence rate ratio 0.57, 95% CI 0.54–0.60; gynecologic: incidence rate ratio 0.59, 95% CI 0.56–0.62) (Table 1). Compared with the corresponding period in 2019, there were significant decreases in ED presentations in the early and late COVID-19 pandemic periods (both P<.001). There were no meaningful clinical differences in changes in ED utilization when stratified by race between the prepandemic period and both the early and late pandemic periods.

Fig. 1.

Incidence of emergency department (ED) visits for obstetric and gynecologic conditions before and during the coronavirus disease 2019 (COVID-19) pandemic. Data were obtained from Kaiser Permanente Northern California (KPNC) electronic medical record. Data in red represent the estimated weekly incidence rate of obstetric and gynecologic visits to the ED per 100,000 person-weeks from January 1 to September 1, 2019. Data in blue represent the same estimates from January 1 to September 1, 2020, during the COVID-19 pandemic. Person-weeks were calculated according to the total adult (18 years of age or older) membership of KPNC at the middle of each monthly period. Vertical bars indicate 95% CIs. The data in black represent the number of patients diagnosed with COVID-19 in Northern California per 100,000 person-weeks, and the data in grey represent the number of patients hospitalized with COVID-19 in Northern California per 100,000 person-week. These rates are calculated using data from the official California Department of Public Health COVID-19 statistics, limited to Northern California counties and the current population of Northern California (approximately 15.7 million).

Abel. COVID-19 and Obstetrics and Gynecology ED Visits. Obstet Gynecol 2021.

DISCUSSION

In this integrated health care system, the incidence of obstetric and gynecologic visits to the ED declined precipitously by 42% between March and May 2020 but then returned to near-2019 levels despite a substantial increase in COVID-19 cases and hospitalizations across California. This large-scale study demonstrates significant changes in obstetric and gynecologic emergency care likely due to COVID-19. These results highlight the need for hospitals to promote access to safe care during this and future pandemics, update plans for disaster-preparedness care and later COVID-19 surges, and encourage community outreach to mitigate fears of contracting COVID-19.